Bunions are a sometimes painful dislocation of the first metatarsophalangeal joint or fifth metatarsophalangeal joint that occurs primarily in shod (i.e., shoe-wearing) populations. There have been many suggested causes of bunions, but perhaps the most significant is the tapering toe boxes present in most conventional footwear. Tapering toe boxes have a long history of inclusion in most shoe models, including athletic shoes.
An unfortunate side effect of the tapering toe box is that it holds the toe bones and their associated joints in unnatural proximity to one another, forcing the great toe into the space that should be occupied by the second toe. This chronic deviation of the big toe toward the midline of the foot is the stimulus for the classic bunion deformity
. A bunionette
, which is located on the outside aspect of the foot, is created when the fifth toe is forced under the fourth toe and when the head of the fifth metatarsal bone is forced into the outer aspect of the shoe, sometimes causing pain, swelling, or bursa formation.
Unfortunately, the toe box taper built into most footwear begins at the metatarsophalangeal joints (i.e., at the ball of the foot) instead of at the ends of the toes, where the natural forefoot shape is at its widest
. The only opportunity to see the natural shape of a human forefoot in America is to view the feet of a newborn or by viewing the feet of an individual who grew up in a barefoot culture
. While it’s unusual in America, barefoot living is common in many parts of the world. Members of unshod cultures rarely experience the common forefoot deformities and problems prevalent in America
, such as bunions
, and neuromas
are another forefoot deformity that can keep a person from participating in certain athletic activities, such as walking or running. Hammertoes are often indicative of a tendon imbalance in the toes caused by one of the toe tendons gaining an advantage over another. Most commonly, it’s one (or all) of the long extensor tendons on the top of the foot that gains an advantage over one (or all) of the flexor tendons on the bottom of the foot. This imbalance in tone and tension causes the first joint in the toe to be elevated above the level of the ground (and, correspondingly, above the level of the ball of the foot). By wearing conventional footwear that possesses a variety of injurious design features
, most people are altering the delicate balance that exists between the toe flexor and extensor tendons.
This tendon imbalance occurs because most footwear has heel elevation and a feature called toe spring. These two features, along with the tapering toe boxes mentioned above, are responsible for the development of most hammertoe and bunion deformities. Hammertoes generally cause walkers and runners to experience pain and dysfunction in three distinct areas:
1. On the top of the contracted joint (known as the proximal interphalangeal joint), due to callus buildup or bursa formation that occurs from the toe joint repeatedly rubbing against the top of the shoe’s toe box.
2. On the tip of the toe, since there’s an unnatural bend in the toe that places focal pressure at the distal-most (or furthest) aspect of the toe (Note: This becomes a problem because the skin on the end of the toe is not as strong and resilient as the skin on the bottom of the toe).
3. Under the ball of the foot (Note: When a toe becomes hammered (or “contracted”), downward pressure is placed on the corresponding metatarsal bone, causing pain, swelling, and sometimes callus formation).
Prevention and Treatment
The following tips may be helpful in reversing a painful bunion or hammertoe deformity, but they’re most effective when applied in a preventative fashion, in younger people. Because the body’s joints are excellent at adapting to the positions they’re most frequently held in, the longer a person allows his or her joint deformity to progress, the lower the likelihood the ailment will be cured. The feet, unfortunately, are no exception. Most people, by using inappropriate footwear, hold their toes and feet in an altered position for 12 to 15 hours per day.
If a person wishes to prevent or cure a bunion or hammertoe deformity through noninvasive and natural means, he or she must be willing to view footwear as “health equipment” rather than fashion statements. When it comes to buying footwear, market trends show us that fashion and style (even when it comes to athletic footwear) rule most people’s agenda. Function seldom wins out over form.
Finding a shoe that’s wide enough to splay the toes the way nature intended (enabled by Correct Toes) is extremely important. A good method for ensuring that your toes will have enough room in a pair of shoes is to remove the sock liners that come with the shoes and stand on one of them, placing the full weight of your body on the liner (this is called the Shoe Liner Test). If all your toes lie flat and are contained within the outer boundaries of the liner (i.e., if none of your toes are hanging off the edge of the liner), you’ve found an appropriately sized pair of shoes. This test can also produce deceptive results if your feet have already been deformed by conventional footwear, such that your feet more closely resemble the shape of shoes with tapering toe boxes and not the shape of an undeformed human foot; this is why we recommend wearing Correct Toes when performing the Shoe Liner Test. The footwear you buy should allow your toes to splay during gait, which is what nature intended.
Range of motion exercises and manipulation/relocation of bunions and hammertoes into the correct joint position help promote reversal of these deformities. These services can be provided by a trained physician or may be performed at home by you as part of a regular wellness program. Other exercises you can perform at home for bunions and hammertoes include the Big Toe Stretch and the Hammertoe Stretch, respectively. Please note that these exercises will only be successful over the long term if you adopt footwear that allows your foot to function like a bare foot inside your shoe.
Most toe deformities are caused by conventional footwear. If you wish to avoid the onset of bunions and hammertoes (along with ankle, knee, hip, and lower back pain), or if you’re interested in reversing the severity of your foot problems, please select footwear that is completely flat from heel to toe, is wide enough in the toe box to allow you to spread your toes, and possesses a sole that can be easily bent or twisted. You can read more here about our definition of a healthy shoe.